Provider Demographics
NPI:1407955891
Name:BARTLETT, TERRY A
Entity Type:Individual
Prefix:MR
First Name:TERRY
Middle Name:A
Last Name:BARTLETT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2770 OLIVE HWY
Mailing Address - Street 2:STE. D
Mailing Address - City:OROVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95966-6117
Mailing Address - Country:US
Mailing Address - Phone:530-533-8912
Mailing Address - Fax:530-533-8912
Practice Address - Street 1:2770 OLIVE HWY
Practice Address - Street 2:STE. D
Practice Address - City:OROVILLE
Practice Address - State:CA
Practice Address - Zip Code:95966-6117
Practice Address - Country:US
Practice Address - Phone:530-533-8912
Practice Address - Fax:530-533-8912
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA2353237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ76038ZMedicaid